'Domino transplant' saves lives of two

Rare procedure is a method of coping with donor shortages

Updated 11:43 am, Wednesday, August 21, 2013

Organ recipient Tiffany Schwantes, 31, visits organ donor Vernon Roberson at Houston Methodist Hospital. Roberson received a new liver and donated his liver to Schwantes in a "domino transplant."

Organ recipient Tiffany Schwantes, 31, visits organ donor Vernon Roberson at Houston Methodist Hospital. Roberson received a new liver and donated his liver to Schwantes in a "domino transplant."

Photo: Mayra Beltran, Staff

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Organ recipient Tiffany Schwantes, 31, visits organ donor Vernon Roberson weeks after surgeons at Houston Methodist Hospital performed a "domino" transplant on Thursday, Aug. 15, 2013, in Houston. The "domino" transplant is a procedure that's done on two people at the same time. Roberson, who suffered from with amyloidosis (a blood disease that attacks and damages the heart, liver, and other organs) needed a heart and liver transplant. Schwantes has bile duct cancer and was going to die without a liver transplant. They transplanted Roberson's heart, took out his liver, and implanted it into Schwantes. Even though the liver was diseased with amyloidosis, it saved her life. Schwantes was so far down on the transplant list that she never would have survived without it. Doctors said it will take her 25 to 30 years to develop amyloidosis, and in that time, she can receive a new liver. ( Mayra Beltran / Houston Chronicle ) less

Organ recipient Tiffany Schwantes, 31, begins to weep during her visit with organ donor Vernon Roberson weeks after surgeons at Houston Methodist Hospital performed a "domino" transplant on Thursday, Aug. 15, 2013, in Houston. The "domino" transplant is a procedure that's done on two people at the same time. Roberson, who suffered from with amyloidosis (a blood disease that attacks and damages the heart, liver, and other organs) needed a heart and liver transplant. Schwantes has bile duct cancer and was going to die without a liver transplant. They transplanted Roberson's heart, took out his liver, and implanted it into Schwantes. Even though the liver was diseased with amyloidosis, it saved her life. Schwantes was so far down on the transplant list that she never would have survived without it. Doctors said it will take her 25 to 30 years to develop amyloidosis, and in that time, she can receive a new liver. ( Mayra Beltran / Houston Chronicle ) less

Organ recipient Tiffany Schwantes, 31, begins to weep during her visit with organ donor Vernon Roberson weeks after surgeons at Houston Methodist Hospital performed a "domino" transplant on Thursday, Aug. 15, ... more

Photo: Mayra Beltran, Staff

'Domino transplant' saves lives of two

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On a late afternoon in July, 31-year-old Tiffany Schwantes got a phone call at her Alabama home, prompting a difficult but speedy decision.

Two years earlier, the wife and mother was diagnosed with cholangiocarcinoma, a rare, aggressive form of liver cancer. She knew she didn't have long to live, but she was at the bottom of the transplant list.

The need: Someone is added to the National Organ Transplant waiting list in the U.S. every 11 minutes.

Registry: Go to the Glenda Dawson Donate Life-Texas Registry at donatelifetexas.org to register as a donor.

Schwantes called other doctors for second opinions, she talked to her husband, she cried and then made her decision. Less than half a day later she was in a Houston Methodist operating room, across a short corridor from Roberson who was doing the same.

"He (Roberson) saved my life," said Schwantes, whose cancer is now in remission. "He didn't have to do that."

The surgery, called a "domino transplant," is rare and involves a living donor donating an organ while receiving another organ from someone else, doctors said.

With a growing organ donor shortage and more than 110,000 people in the United States awaiting transplants, doctors are looking for innovative solutions such as this to close the gap, said Dr. A. Osama Gaber, director of transplantation at Houston Methodist.

Anyone can register to be an organ donor, with few exceptions such as those with HIV or active cancer. Of more than 4 million registered organ donors, only 1 percent will actually become organ donors, according to Laura Frnka-Davis of LifeGift.

For your organs to help another after you die, you essentially need to die of cardiac arrest while on life support in a health care facility. That means, for example, that if you die in a car accident on a freeway, your organs won't be viable for transplantation.

More than 11,000 Texans are waiting for transplants today. During the past 15 years, more organs, such as Roberson's damaged liver, have been used to address the organ shortage, Gaber said. In cases like this one, it's because adding years to Schwantes' life outweighs the chance that she could develop the disease Roberson had.

"What we do is give these livers to people for whom that amount of survival would be a tremendous advantage, like a patient with cancer," he said.

Roberson said that when doctors told him that his liver could save someone else, he didn't hesitate.

This type of transplantation itself is quite an undertaking. Dr. Mark Ghobrial, who performed and coordinated the 12-hour surgery, said the transplant team involved nearly 50 people, including four liver surgeons, two cardiac surgeons and two anesthesia teams.

The transplant surgery is made even more demanding because surgeons must preserve all the blood flow in the organ, so that it remains viable for the recipient, said Ghobrial, director of the center for liver disease and transplantation at Houston Methodist.

A few days after the surgery, Schwantes was excited to meet Roberson.

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"It made me feel like there are still some good people in this word," she said, noting that her new liver had renewed her faith in humanity.

Roberson wants to thank the family who donated their loved one's heart and liver to him. "It's important for me to meet them," he said. "They did the same thing I did."